Abstract
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and may result in an overactive coagulative system, thereby resulting in serious cardiovascular consequences in critically affected patients. The respiratory tract is a primary target for COVID-19 infection, which is manifested as acute lung injury in the most severe form of the viral infection, leading to respiratory failure. A proportion of infected patients may progress to serious systemic disease including dysfunction of multiple organs, acute respiratory distress syndrome (ARDS), and coagulation abnormalities, all of which are associated with increased mortality, additionally depending on age and compromised immunity. Coagulation abnormalities associated with COVID-19 mimic other systemic coagulopathies otherwise involved in other severe infections, such as disseminated intravascular coagulation (DIC) and may be termed COVID-19 induced coagulopathy (CIC). There is substantial evidence that patients with severe COVID-19 exhibiting CIC can develop venous and arterial thromboembolic complications. In the initial stages of CIC, significant elevation of D-dimer and fibrin/fibrinogen degradation products is observed. Alteration in prothrombin time, activated partial thromboplastin time, and platelet counts are less common in the early phase of the disease. In patients admitted to intensive care units (ICUs), coagulation test screening involving the measurement of D-dimer and fibrinogen levels, has been recommended. Prior established protocols for thromboembolic prophylaxis are also followed for CIC, including the use of heparin and other standard supportive care measures. In the present review, we summarize the characteristics of CIC and its implications for thrombosis, clinical findings of coagulation parameters in SARS-CoV-2 infected patients with incidences of thromboembolic events and plausible therapeutic measures.
Highlights
Coronavirus disease of 2019 (COVID-19) is a viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1–4] Because of its highly contagious nature and global spread, it was declared a pandemic by WHO since early March 2020.5 SARS-CoV-2 comprises of positive-sense single-stranded RNA genome harboring a surface glycoprotein known as spike protein, or S proteins
Endothelial dysfunction caused by viral entry results in elevated levels of D-dimer along with thrombin and fibrin degradation products (FDP), inflammation and hypoxia resulting in COVID-19 induced coagulopathy’ (CIC) which can lead to pulmonary congestion mediated by thrombosis.[79]
With the new molecular mechanistic insights emerging from the concerted efforts of biomedical research, more opportunities will arise to identify potentially safe and effective therapeutic strategies for COVID-19. This pandemic has jeopardized the security and stability of the entire human race for an unknown future duration, COVID-19 Induced Coagulopathy Sharma et al e77 plunging it into uncharted territory, leaving all of us feeling powerless in the face of an infectious and invisible threat
Summary
Coronavirus disease of 2019 (COVID-19) is a viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1–4] Because of its highly contagious nature and global spread, it was declared a pandemic by WHO since early March 2020.5 SARS-CoV-2 comprises of positive-sense single-stranded RNA genome harboring a surface glycoprotein known as spike protein, or S proteins.
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